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Geographic Distribution

Until the latter part of the 19th century, typhoid fever was endemic throughout most of the world. Since the introduction of modern sanitation for the disposal of feces and waterborne waste, and the general availability of purified water throughout most of North America, western Europe and Austalasia, typhoid fever has declined progressively in incidence and importance to the point where today only occasional imported cases are seen in the developed nations of the world. It still persists as a serious disease and public health problem in the less developed countries, where proper sanitation and fresh water supplies are deficient. Typhoid fever remains endemic throughout Africa, the Middle East, India and most of Asia, and Central and South America.

WHO and UNICEF estimated that, as of 1990, 265 million of the 500 million people living in sub-Saharan Africa lacked safe drinking water and 344 million lived without adequate sanitation facilities. Progress since then has been largely offset by population growth, droughts, and the resurgence of cholera, typhoid, and other water-related diseases. Existing water and sanitation facilities are inadequate and rapidly deteriorating in many areas, affecting especially the millions of refugees and displaced persons in Africa, who fall victim to the deadly combination of malnutrition and diarrheal illnesses.

Paratyphoid A fever is the most common form of enteric fever in India and other eastern countries, whereas paratyphoid B is more common in southern and eastern Europe. Paratyphoid C fever, which resembles the illnesses caused by S. typhimurium and S. choleraesuis, is prevalent in Guyana.

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